Deprescribing statins for adults 65 years of age and older: Evidence-based clinical practice guideline.

چکیده اصلی

OBJECTIVE: To develop an evidence-based guideline to support clinicians in making decisions around continuation or discontinuation (deprescribing) of a statin for their older patients. METHODS: The target audience was clinicians. The scope was patients 65 years and older taking statins. Deprescribing was defined as discontinuation. The guideline was developed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The guideline panel included 10 clinicians (family physicians, pharmacists, a geriatrician, a cardiologist, a neurologist, and a nurse practitioner) and 1 patient and public member. There was a patient and public consultant group of 5 people 65 years and older taking statins. Recommendations were informed by evidence reviews on the benefits and harms of deprescribing versus continuation of statins; benefits and harms of initiating statins in older adults; feasibility, acceptability, equity, and patient preferences related to statin deprescribing; and resource implications of statin deprescribing. The team refined recommendations through consensus and synthesized clinical considerations relevant to practice. The guideline was reviewed by clinicians and interest holders, and their feedback was incorporated into the guideline. RECOMMENDATIONS: All decisions should be tailored to the individual and include a conversation with patients and carers. Decisions may be informed by consideration of function, mobility, cognition, level of frailty, social circumstances, life expectancy, pill burden, and patient values, preferences, and health care goals. The guideline panel suggests deprescribing statins in older adults at the end of life; continuing statins for primary prevention in older adults who are not at the end of life; continuing statins for secondary prevention in older adults who are not at the end of life; and offering a conversation about continuing or discontinuing statins for select patients. CONCLUSION: This guideline supports patient-centred decision making around statin use for older adults. The recommendations are meant to be discussed together with patients and carers to reach decisions that reflect individual patient characteristics, values, preferences, and health care goals.

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